22. European Stroke Conference 5 Stroke prevention A 11:10 - 11:20 Low risk of ischaemic stroke distal to asymptomatic carotid stenosis on contemporary medical treatment: population-based cohort study M.T. Cooney1, L. Marquardt2, Z. Mehta3, L. Li4, P.M. Rothwell5 of behalf of the oxford Vascular Study Nuffield Dept of Clinical Neurology, University of Oxford, Oxford, UNITED KING-DOM1, Dept of Neurology, University of Erlangen, Erlangen, GERMANY2, Nuffield Dept of Clinical Neurology, University of Oxford, Oxford, UNITED KINGDOM3, Nuffield Dept of Clinical Neurology, University of Oxford, Oxford, UNITED KINGDOM4, Nuffield Dept of Clinical Neurology, University of Oxford, Oxford, UNITED KINGDOM5 BACKGROUND: Carotid endarterectomy reduces risk of stroke compared to best medical therapy (BMT) alone in patients with ≥ 60% asymptomatic carotid stenosis. However, BMT has improved in recent years and the risk of cerebrovascular events distal to asymptomatic ca-rotid stenosis in patients on BMT only may have fallen. METHODS: In a population-based study of all patients with TIA or stroke (Oxford Vascular Study), we studied the risk of cere-brovascular events distal to clinically significant (≥50% stenosis by NASCET method; ≥70% stenosis by ECST method) asymptomatic carotid stenosis in patients recruited consecutively from 2002-2012 and given contemporary medical treatment. RESULTS: Of 1,715 consecu-tively imaged patients presenting with stroke or TIA, 285 had significant stenosis of at least one carotid bifurcation, which was asymptomatic in 129 patients (mean age 76.5 years; 39% women; 45% aged ≥80 years). During 476 patient-years of follow-up (mean = 3.7 years), there were 9 - 3 strokes and 6 TIAs. The average annual risks ischaemic events in the territory of an asymptomatic stenosis were 0.63 (95%CI: 0.20 to 1.95) for any ipsilateral carotid territory ischaemic stroke (3 events) and 1.29 (95%CI: 0.58 to 2.86) for ipsilateral TIA (6 events). Of the three patients with ipsilateral stroke, two had disabling events associated with atrial fibrillation at the time of stroke, and one had a non-disabling definite non-cardioembolic stroke. CON-CLUSIONS: The risk of definite non-cardioembolic ischaemic stroke distal to an asymptomatic carotid stenosis on contemporary medical treatment was low (one event in 476 patient-years), raising uncertainty about the benefit of carotid revascularisation in this patient group. 4 Stroke prevention A 11:00 - 11:10 Classification, Prognosis and Response to Treatment of Lacunar Strokes Based on Likely Pathogenic Mechanism: The SPS3 Trial O.R. Benavente1, L.A. McClure2, C. Bazan3, D. Anderson4, J. Roquer5, R.G. Hart6 University of British Columbia, Vancouver, CANADA1,University of Alabama at Birming-ham, Birmingham, USA2, University of Texas, San Antonio, USA3, University of Minnesota, Miniapolis, USA4, Hospital del Mar, Barcelona, SPAIN5, University of McMaster, Hamilton, CANADA6 Background: Lacunar infarcts are the most common clinical manifestation of small vessel disease (SVD), mostly due to occlusion of a small penetrating artery. However, other mechanisms of brain ischemia can be responsible. We aimed to characterize lacunar strokes based on their likely pathogenic mechanism. Methods: Data are from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Baseline lacunar strokes were classified into 3 categories based on MRI (single vs multiple infarcts) and MRA (intracranial stenosis) findings: 1) Likely-SVD (multiple infarcts + no stenosis or stenosis on other vascular territory of index event); 2) Probable-SVD (single infarct + no stenosis) and 3) Unlikely-SVD (single or multiple infarcts + stenosis in the same territory of index event). Results: Out of 2804 patients, 1051 (37%) were classified as likely-SVD, 1403 (50%) as probable-SVD and 350 (17%) as unlikely-SVD. Non-hispanic whites had more probable-SVD (54%), blacks had more unlikely-SVD disease (23%) and hispanics more likely-SVD (34%) (p<0.0008). Those classified as unlikely-SVD were older, and had more hypertension, diabetes and hy-perlipidemia (93%, 51% and 54% respectively) than the other groups (p<0.001). Recurrent strokes occurred among 99 with likely-SVD, 75 with probable-SVD and 37 with unlikely-SVD (p<0.001). Annual recurrence rate for ischemic stroke was 3% for likely-SVD, 2% for proba-ble- SVD and 3% unlikely-SVD. The effect of antiplatelet therapy (ASA vs. ASA+clopidogrel) and systolic blood pressure targets (“higher group” 130-149 mmHg vs. “lower group” <130 mmHg) by pathogenic mechanism will be presented. Conclusions: In this large, well-defined cohort of lacunar stroke patients we identified, based on neuroimag-ing features, three distinct groups with likely distinct pathogenic mechanisms Differences in de-mographics and vascular risk factors are present among the groups. Ongoing analysis of SPS3 will likely elucidate the heterogeneity of lacunar stroke respect to prognosis and response to therapy. 122 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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